Injury
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Review Practice Guideline
Paediatric injuries around the knee: Soft tissue injuries.
We review the diagnosis, management and potential pitfalls of acute soft tissue injuries in the skeletally immature knee, including anterior cruciate ligament (ACL) injuries, meniscal injuries, patellar dislocation and patellofemoral instability (PFI). There has been an increasing incidence of such injuries in the paediatric population, and controversy remains regarding their treatment. We summarise evidence-based treatments for these injuries and discuss strategies to minimise complications as the child reaches skeletal maturity.
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This multicentre case-control study compares Vancouver Classification System (VCS) grade and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) fracture type in interprosthetic femoral fractures (IPFFs) between primary total hip arthroplasty (THA) and ipsilateral total knee arthroplasty (TKA) to periprosthetic femoral fracture (PFF) without ipsilateral TKA. ⋯ The presence of an ipsilateral TKA affects the location of PFF with more fractures occurring distal to the stem. A greater proportion of bending type fractures occurred when an ipsilateral TKA was present. These unstable fractures often require more complex surgery.
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Randomized Controlled Trial
The effect of a controlled mandible position mouthguard on upper body strength and power in trained rugby athletes - A randomized within subject study.
It is widely accepted that mouthguards are effective for injury protection in sports. However, findings on the effects of mouthguards in strength and power production remains controversial. Therefore, the aim of this study was to determine whether controlled-mandible position mouthguards influence strength and power production in well trained athletes. ⋯ Controlled mouthguards enhance peak force and peak acceleration in the ballistic bench press exercise without negatively affecting any other measure assessed in this study. We speculate that this is possibly due to an increased stability of temporomandibular joint.
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3D-printed implants could improve the capture of fracture fragments for improved stability of tibial plateau fracture fixation. The aim of this study was to compare the biomechanical strength of fixation constructs using standard and customised 3D-printed proximal tibial locking plates for fixation of tibial plateau fractures. ⋯ Production of customised plates for proximal tibia fractures at point-of-care is feasible, however fixation constructs with these plates did not provide any biomechanical advantage over standard plates in terms of axial loading stiffness.
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Femoral neck fractures in the young patient present a unique challenge. Most surgeons managing these injuries prefer a fixed angle implant, however these devices are fraught with problems. A dynamic hip screw (DHS) is one such fixed angle device that risks malreduction through rotational torque during screw insertion. To avoid this risk some surgeons utilize a dynamic helical hip system (DHHS), however little is known about the complication profile of this device. We hypothesized that the complication rate between these two devices would be similar. ⋯ This study demonstrates a high risk of complication when managing young femoral neck fractures in line with prior literature. The major complication rate of non-union requiring osteotomy or fixation failure resulting in THA was no different between the two groups, but the rate of shortening was greater the DHS group. This data suggests the DHHS may be a suitable device to manage the young femoral neck fracture and without increased risk of complication.